Mandatory Data Elements and Terminology

Each MeasureReport must have:

1. A MeasureReport.status element
2. A MeasureReport.type element hard coded to “individual”
3. A MeasureReport.measure element references a Risk Adjustment Model Measure
4. A MeasureReport.subject element references a US Core Patient profile
5. A MeasureReport.period element for the clinical evaluation period for which the risk adjustment coding gap report was generated.

Each MeasureReport should have ([Must Support]):

1. Zero to many MeasureReport.group element
2. Each MeasureReport.group should have a MeasureReport.group.code element
3. Each MeasureReport.group should have a MeasureReport.group.suspectType element
4. Each MeasureReport.group should have a MeasureReport.group.evidenceStatus element
5. Each MeasureReport.group should have a MeasureReport.group.evidenceStatusDate element
6. Each MeasureReport.group should have a MeasureReport.group.hierarchicalStatus element
7. Each MeasureReport.group should have zero to many MeasureReport.evalautedResource element

Additional Profile specific implementation guidance:

1. evaluatedResource SHALL reference resources using USCore profiles where applicable

The Clinical Data Collection Deadline element, clinicalDataCollectionDeadline, was added as an extension to MeasureReport. We are seeking comment from implementers if they intend to use this element when communicating risk adjustment coding gap reports from payers to providers.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from MeasureReport

Name	Flags	Card.	Type	Description & Constraints
MeasureReport		0..*	MeasureReport	This is a risk adjustment coding gap report.
clinicalDataCollectionDeadline	S	0..1	date	This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline
status	S	1..1	code	complete | pending | error
type	S	1..1	code	The type code is fixed to 'individual' for a risk adjustment coding gap report Fixed Value: individual
measure	S	1..1	canonical(Risk Adjustment Model Measure)	This references a measure that represents a risk adjustment model, such as CMS-HCC V24.
subject	S	1..1	Reference(US Core Patient Profile)	What individual(s) the report is for
date	S	1..1	dateTime	When the report was generated
reporter	S	1..1	Reference(US Core Organization Profile)	Organization that generated the MeasureReport
period	SC	1..1	Period	Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
start	S	1..1	dateTime	Starting time with inclusive boundary
end	S	1..1	dateTime	End time with inclusive boundary, if not ongoing
group	S	0..*	BackboneElement	A group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category.
id	S	1..1	string	Unique id for inter-element referencing
suspectType	S	0..1	CodeableConcept	This is the risk adjustment suspect type for a Condition Category (CC) gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType Binding: Risk Adjustment Suspect Type ValueSet (extensible)
evidenceStatus	S	0..1	CodeableConcept	This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Risk Adjustment Evidence Status ValueSet (extensible)
evidenceStatusDate	S	0..1	date	When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
hierarchicalStatus	S	0..1	CodeableConcept	This is to indicate whether hierarchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Risk Adjustment Hierarchical Status ValueSet (extensible)
confidenceScale	S	0..1	CodeableConcept	Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: Confidence Scale Value Set (extensible)
annotation	S	0..*	(Complex)	Annotation URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-annotation
code	S	0..1	CodeableConcept	Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example)
stratifier
code		0..1	CodeableConcept	What stratifier of the group
evaluatedResource	S	0..*	Reference(Resource)	An evaluated resource is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap.
groupReference	S	0..*	string	This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
MeasureReport.group.code	example	SampleCMSHCC

Constraints

Id	Grade	Path(s)	Details	Requirements
ra-1	error	MeasureReport.period	Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.value.matches('^([0-9]{4})(-)(1[0-2]|0[1-9])-(3[01]|0[1-9]|[12][0-9]).*') and end.value.matches('^([0-9]{4})(-)(1[0-2]|0[1-9])-(3[01]|0[1-9]|[12][0-9]).*')

Name	Flags	Card.	Type	Description & Constraints
MeasureReport	C	0..*	MeasureReport	This is a risk adjustment coding gap report.
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
clinicalDataCollectionDeadline	S	0..1	date	This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	complete | pending | error Binding: MeasureReportStatus (required): The status of the measure report.
type	SΣC	1..1	code	The type code is fixed to 'individual' for a risk adjustment coding gap report Binding: MeasureReportType (required): The type of the measure report. Fixed Value: individual
measure	SΣ	1..1	canonical(Risk Adjustment Model Measure)	This references a measure that represents a risk adjustment model, such as CMS-HCC V24.
subject	SΣ	1..1	Reference(US Core Patient Profile)	What individual(s) the report is for
date	SΣ	1..1	dateTime	When the report was generated
reporter	SΣ	1..1	Reference(US Core Organization Profile)	Organization that generated the MeasureReport
period	SΣC	1..1	Period	Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	SΣC	1..1	dateTime	End time with inclusive boundary, if not ongoing
improvementNotation	?!Σ	0..1	CodeableConcept	increase | decrease Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.
group	SC	0..*	BackboneElement	A group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category.
id	S	1..1	string	Unique id for inter-element referencing
suspectType	S	0..1	CodeableConcept	This is the risk adjustment suspect type for a Condition Category (CC) gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType Binding: Risk Adjustment Suspect Type ValueSet (extensible)
evidenceStatus	S	0..1	CodeableConcept	This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Risk Adjustment Evidence Status ValueSet (extensible)
evidenceStatusDate	S	0..1	date	When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
hierarchicalStatus	S	0..1	CodeableConcept	This is to indicate whether hierarchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Risk Adjustment Hierarchical Status ValueSet (extensible)
confidenceScale	S	0..1	CodeableConcept	Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: Confidence Scale Value Set (extensible)
annotation	S	0..*	(Complex)	Annotation URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-annotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	0..1	CodeableConcept	Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example)
evaluatedResource	S	0..*	Reference(Resource)	An evaluated resource is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap.
groupReference	S	0..*	string	This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
MeasureReport.status	required	MeasureReportStatus
MeasureReport.type	required	Fixed Value: individual
MeasureReport.improvementNotation	required	MeasureImprovementNotation
MeasureReport.group.code	example	SampleCMSHCC

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MeasureReport	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MeasureReport	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	MeasureReport	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	MeasureReport	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MeasureReport	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mrp-1	error	MeasureReport	Measure Reports used for data collection SHALL NOT communicate group and score information : (type != 'data-collection') or group.exists().not()
mrp-2	error	MeasureReport	Stratifiers SHALL be either a single criteria or a set of criteria components : group.stratifier.stratum.all(value.exists() xor component.exists())
ra-1	error	MeasureReport.period	Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.value.matches('^([0-9]{4})(-)(1[0-2]|0[1-9])-(3[01]|0[1-9]|[12][0-9]).*') and end.value.matches('^([0-9]{4})(-)(1[0-2]|0[1-9])-(3[01]|0[1-9]|[12][0-9]).*')

Name	Flags	Card.	Type	Description & Constraints
MeasureReport	C	0..*	MeasureReport	This is a risk adjustment coding gap report.
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
clinicalDataCollectionDeadline	S	0..1	date	This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Additional identifier for the MeasureReport
status	?!SΣ	1..1	code	complete | pending | error Binding: MeasureReportStatus (required): The status of the measure report.
type	SΣC	1..1	code	The type code is fixed to 'individual' for a risk adjustment coding gap report Binding: MeasureReportType (required): The type of the measure report. Fixed Value: individual
measure	SΣ	1..1	canonical(Risk Adjustment Model Measure)	This references a measure that represents a risk adjustment model, such as CMS-HCC V24.
subject	SΣ	1..1	Reference(US Core Patient Profile)	What individual(s) the report is for
date	SΣ	1..1	dateTime	When the report was generated
reporter	SΣ	1..1	Reference(US Core Organization Profile)	Organization that generated the MeasureReport
period	SΣC	1..1	Period	Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	SΣC	1..1	dateTime	End time with inclusive boundary, if not ongoing
improvementNotation	?!Σ	0..1	CodeableConcept	increase | decrease Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.
group	SC	0..*	BackboneElement	A group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category.
id	S	1..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
suspectType	S	0..1	CodeableConcept	This is the risk adjustment suspect type for a Condition Category (CC) gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType Binding: Risk Adjustment Suspect Type ValueSet (extensible)
evidenceStatus	S	0..1	CodeableConcept	This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Risk Adjustment Evidence Status ValueSet (extensible)
evidenceStatusDate	S	0..1	date	When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
hierarchicalStatus	S	0..1	CodeableConcept	This is to indicate whether hierarchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Risk Adjustment Hierarchical Status ValueSet (extensible)
confidenceScale	S	0..1	CodeableConcept	Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: Confidence Scale Value Set (extensible)
annotation	S	0..*	(Complex)	Annotation URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-annotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	0..1	CodeableConcept	Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example)
population		0..*	BackboneElement	The populations in the group
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	0..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Binding: MeasurePopulationType (extensible): The type of population (e.g. initial, numerator, denominator, etc.).
count		0..1	integer	Size of the population
subjectResults		0..1	Reference(List)	For subject-list reports, the subject results in this population
measureScore	Σ	0..1	Quantity	What score this group achieved
stratifier		0..*	BackboneElement	Stratification results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	What stratifier of the group
stratum		0..*	BackboneElement	Stratum results, one for each unique value, or set of values, in the stratifier, or stratifier components
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value		0..1	CodeableConcept	The stratum value, e.g. male
component		0..*	BackboneElement	Stratifier component values
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	What stratifier component of the group
value		1..1	CodeableConcept	The stratum component value, e.g. male
population		0..*	BackboneElement	Population results in this stratum
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Binding: MeasurePopulationType (extensible): The type of population (e.g. initial, numerator, denominator, etc.).
count		0..1	integer	Size of the population
subjectResults		0..1	Reference(List)	For subject-list reports, the subject results in this population
measureScore		0..1	Quantity	What score this stratum achieved
evaluatedResource	S	0..*	Reference(Resource)	An evaluated resource is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
groupReference	S	0..*	string	This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
MeasureReport.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
MeasureReport.status	required	MeasureReportStatus
MeasureReport.type	required	Fixed Value: individual
MeasureReport.improvementNotation	required	MeasureImprovementNotation
MeasureReport.group.code	example	SampleCMSHCC
MeasureReport.group.population.code	extensible	MeasurePopulationType
MeasureReport.group.stratifier.stratum.population.code	extensible	MeasurePopulationType
MeasureReport.evaluatedResource.type	extensible	ResourceType

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ra-1	error	MeasureReport.period	Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.value.matches('^([0-9]{4})(-)(1[0-2]|0[1-9])-(3[01]|0[1-9]|[12][0-9]).*') and end.value.matches('^([0-9]{4})(-)(1[0-2]|0[1-9])-(3[01]|0[1-9]|[12][0-9]).*')

Differential View

This structure is derived from MeasureReport

Name	Flags	Card.	Type	Description & Constraints
MeasureReport		0..*	MeasureReport	This is a risk adjustment coding gap report.
clinicalDataCollectionDeadline	S	0..1	date	This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline
status	S	1..1	code	complete | pending | error
type	S	1..1	code	The type code is fixed to 'individual' for a risk adjustment coding gap report Fixed Value: individual
measure	S	1..1	canonical(Risk Adjustment Model Measure)	This references a measure that represents a risk adjustment model, such as CMS-HCC V24.
subject	S	1..1	Reference(US Core Patient Profile)	What individual(s) the report is for
date	S	1..1	dateTime	When the report was generated
reporter	S	1..1	Reference(US Core Organization Profile)	Organization that generated the MeasureReport
period	SC	1..1	Period	Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
start	S	1..1	dateTime	Starting time with inclusive boundary
end	S	1..1	dateTime	End time with inclusive boundary, if not ongoing
group	S	0..*	BackboneElement	A group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category.
id	S	1..1	string	Unique id for inter-element referencing
suspectType	S	0..1	CodeableConcept	This is the risk adjustment suspect type for a Condition Category (CC) gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType Binding: Risk Adjustment Suspect Type ValueSet (extensible)
evidenceStatus	S	0..1	CodeableConcept	This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Risk Adjustment Evidence Status ValueSet (extensible)
evidenceStatusDate	S	0..1	date	When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
hierarchicalStatus	S	0..1	CodeableConcept	This is to indicate whether hierarchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Risk Adjustment Hierarchical Status ValueSet (extensible)
confidenceScale	S	0..1	CodeableConcept	Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: Confidence Scale Value Set (extensible)
annotation	S	0..*	(Complex)	Annotation URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-annotation
code	S	0..1	CodeableConcept	Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example)
stratifier
code		0..1	CodeableConcept	What stratifier of the group
evaluatedResource	S	0..*	Reference(Resource)	An evaluated resource is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap.
groupReference	S	0..*	string	This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
MeasureReport.group.code	example	SampleCMSHCC

Constraints

Id	Grade	Path(s)	Details	Requirements
ra-1	error	MeasureReport.period	Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.value.matches('^([0-9]{4})(-)(1[0-2]|0[1-9])-(3[01]|0[1-9]|[12][0-9]).*') and end.value.matches('^([0-9]{4})(-)(1[0-2]|0[1-9])-(3[01]|0[1-9]|[12][0-9]).*')

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
MeasureReport	C	0..*	MeasureReport	This is a risk adjustment coding gap report.
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
clinicalDataCollectionDeadline	S	0..1	date	This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	complete | pending | error Binding: MeasureReportStatus (required): The status of the measure report.
type	SΣC	1..1	code	The type code is fixed to 'individual' for a risk adjustment coding gap report Binding: MeasureReportType (required): The type of the measure report. Fixed Value: individual
measure	SΣ	1..1	canonical(Risk Adjustment Model Measure)	This references a measure that represents a risk adjustment model, such as CMS-HCC V24.
subject	SΣ	1..1	Reference(US Core Patient Profile)	What individual(s) the report is for
date	SΣ	1..1	dateTime	When the report was generated
reporter	SΣ	1..1	Reference(US Core Organization Profile)	Organization that generated the MeasureReport
period	SΣC	1..1	Period	Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	SΣC	1..1	dateTime	End time with inclusive boundary, if not ongoing
improvementNotation	?!Σ	0..1	CodeableConcept	increase | decrease Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.
group	SC	0..*	BackboneElement	A group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category.
id	S	1..1	string	Unique id for inter-element referencing
suspectType	S	0..1	CodeableConcept	This is the risk adjustment suspect type for a Condition Category (CC) gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType Binding: Risk Adjustment Suspect Type ValueSet (extensible)
evidenceStatus	S	0..1	CodeableConcept	This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Risk Adjustment Evidence Status ValueSet (extensible)
evidenceStatusDate	S	0..1	date	When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
hierarchicalStatus	S	0..1	CodeableConcept	This is to indicate whether hierarchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Risk Adjustment Hierarchical Status ValueSet (extensible)
confidenceScale	S	0..1	CodeableConcept	Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: Confidence Scale Value Set (extensible)
annotation	S	0..*	(Complex)	Annotation URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-annotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	0..1	CodeableConcept	Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example)
evaluatedResource	S	0..*	Reference(Resource)	An evaluated resource is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap.
groupReference	S	0..*	string	This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
MeasureReport.status	required	MeasureReportStatus
MeasureReport.type	required	Fixed Value: individual
MeasureReport.improvementNotation	required	MeasureImprovementNotation
MeasureReport.group.code	example	SampleCMSHCC

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MeasureReport	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MeasureReport	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	MeasureReport	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	MeasureReport	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MeasureReport	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mrp-1	error	MeasureReport	Measure Reports used for data collection SHALL NOT communicate group and score information : (type != 'data-collection') or group.exists().not()
mrp-2	error	MeasureReport	Stratifiers SHALL be either a single criteria or a set of criteria components : group.stratifier.stratum.all(value.exists() xor component.exists())
ra-1	error	MeasureReport.period	Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.value.matches('^([0-9]{4})(-)(1[0-2]|0[1-9])-(3[01]|0[1-9]|[12][0-9]).*') and end.value.matches('^([0-9]{4})(-)(1[0-2]|0[1-9])-(3[01]|0[1-9]|[12][0-9]).*')

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
MeasureReport	C	0..*	MeasureReport	This is a risk adjustment coding gap report.
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
clinicalDataCollectionDeadline	S	0..1	date	This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Additional identifier for the MeasureReport
status	?!SΣ	1..1	code	complete | pending | error Binding: MeasureReportStatus (required): The status of the measure report.
type	SΣC	1..1	code	The type code is fixed to 'individual' for a risk adjustment coding gap report Binding: MeasureReportType (required): The type of the measure report. Fixed Value: individual
measure	SΣ	1..1	canonical(Risk Adjustment Model Measure)	This references a measure that represents a risk adjustment model, such as CMS-HCC V24.
subject	SΣ	1..1	Reference(US Core Patient Profile)	What individual(s) the report is for
date	SΣ	1..1	dateTime	When the report was generated
reporter	SΣ	1..1	Reference(US Core Organization Profile)	Organization that generated the MeasureReport
period	SΣC	1..1	Period	Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	SΣC	1..1	dateTime	End time with inclusive boundary, if not ongoing
improvementNotation	?!Σ	0..1	CodeableConcept	increase | decrease Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.
group	SC	0..*	BackboneElement	A group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category.
id	S	1..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
suspectType	S	0..1	CodeableConcept	This is the risk adjustment suspect type for a Condition Category (CC) gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType Binding: Risk Adjustment Suspect Type ValueSet (extensible)
evidenceStatus	S	0..1	CodeableConcept	This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Risk Adjustment Evidence Status ValueSet (extensible)
evidenceStatusDate	S	0..1	date	When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
hierarchicalStatus	S	0..1	CodeableConcept	This is to indicate whether hierarchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Risk Adjustment Hierarchical Status ValueSet (extensible)
confidenceScale	S	0..1	CodeableConcept	Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: Confidence Scale Value Set (extensible)
annotation	S	0..*	(Complex)	Annotation URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-annotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	0..1	CodeableConcept	Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example)
population		0..*	BackboneElement	The populations in the group
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	0..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Binding: MeasurePopulationType (extensible): The type of population (e.g. initial, numerator, denominator, etc.).
count		0..1	integer	Size of the population
subjectResults		0..1	Reference(List)	For subject-list reports, the subject results in this population
measureScore	Σ	0..1	Quantity	What score this group achieved
stratifier		0..*	BackboneElement	Stratification results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	What stratifier of the group
stratum		0..*	BackboneElement	Stratum results, one for each unique value, or set of values, in the stratifier, or stratifier components
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value		0..1	CodeableConcept	The stratum value, e.g. male
component		0..*	BackboneElement	Stratifier component values
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	What stratifier component of the group
value		1..1	CodeableConcept	The stratum component value, e.g. male
population		0..*	BackboneElement	Population results in this stratum
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Binding: MeasurePopulationType (extensible): The type of population (e.g. initial, numerator, denominator, etc.).
count		0..1	integer	Size of the population
subjectResults		0..1	Reference(List)	For subject-list reports, the subject results in this population
measureScore		0..1	Quantity	What score this stratum achieved
evaluatedResource	S	0..*	Reference(Resource)	An evaluated resource is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
groupReference	S	0..*	string	This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
MeasureReport.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
MeasureReport.status	required	MeasureReportStatus
MeasureReport.type	required	Fixed Value: individual
MeasureReport.improvementNotation	required	MeasureImprovementNotation
MeasureReport.group.code	example	SampleCMSHCC
MeasureReport.group.population.code	extensible	MeasurePopulationType
MeasureReport.group.stratifier.stratum.population.code	extensible	MeasurePopulationType
MeasureReport.evaluatedResource.type	extensible	ResourceType

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ra-1	error	MeasureReport.period	Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.value.matches('^([0-9]{4})(-)(1[0-2]|0[1-9])-(3[01]|0[1-9]|[12][0-9]).*') and end.value.matches('^([0-9]{4})(-)(1[0-2]|0[1-9])-(3[01]|0[1-9]|[12][0-9]).*')

This structure is derived from MeasureReport

Summary

Mandatory: 6 elements (1 nested mandatory element)
Must-Support: 21 elements
Fixed Value: 1 element

Structures

This structure refers to these other structures:

• Risk Adjustment Model Measure (http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-model-measure)
• US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
• US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline
• http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType
• http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus
• http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
• http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus
• http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale
• http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-annotation
• http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference